Cost-Effectiveness Analysis of Baseline Testing for Resistance-Associated Polymorphisms to Optimize Treatment Outcome in Genotype 1 Noncirrhotic Treatment-Na?ve Patients With Chronic Hepatitis C Virus


Abstract

Objectives: Direct-acting antivirals containing nonstructural protein 5A (NS5A) inhibitors administered over 8 to 12 weeks are effective in ～95% of patients with hepatitis C virus. Nevertheless, patients resistant to NS5A inhibitors have lower cure rates over 8 weeks (<85%); for these patients, 12 weeks of treatment produces cure rates greater than 95%. We evaluated the lifetime cost-effectiveness of testing for NS5A resistance at baseline and optimizing treatment duration accordingly in genotype 1 noncirrhotic treatment-na?ve patients from the perspective of the UK National Health Service.

Methods: A decision-analytic model compared (1) standard 12-week treatment (no testing), (2) shortened 8-week treatment (no testing), and (3) baseline testing with 12-/8-week treatment for those with/without NS5A polymorphisms. Patients who failed first-line therapy were retreated for 12 weeks. Model inputs were derived from published studies. Costs, quality-adjusted life-years, and the probability of cost-effectiveness were calculated.

Results: Baseline testing had an incremental net monetary benefit (INMB) of ￡11 838 versus standard 12 weeks of therapy (no testing) and low probability (31%) of being the most cost-effective, assuming ￡30 000 willingness to pay. Shortened 8 weeks of treatment (no testing) had an INMB of ￡12 294 and the highest probability (69%) of being most cost-effective. Scenario analyses showed baseline testing generally had the highest INMB and probability of being most cost-effective if first- and second-line drug prices were low (<￡20k).

Conclusions: Optimizing treatment duration based on NS5A polymorphisms for genotype 1 noncirrhotic treatment-naive patients in the United Kingdom is not cost-effective if the drug costs are high; the strategy is generally most cost-effective when drug prices are low (<￡20k).

Keywords: baseline testing; cost-effectiveness; hepatitis C virus; resistance-associated polymorphisms.

Figures

Figure?1
Figure?1
One-way sensitivity analysis of NoTest8wks versus NoTest12wks.
Figure?2
Figure?2
One-way sensitivity analysis of Test12/8wks versus NoTest12wks.
Figure?3
Figure?3
Results on the (a) probability of cost-effectiveness and (b) expected incremental net monetary benefit versus 12 weeks (no testing) of various scenario analyses, at ￡30 000 willingness-to-pay: (i) different resistance test costs (assuming 80% reduction in drug costs) and (ii) different first-line cure rates in patients with NS5A resistance (assuming 80% reduction in drug costs).
Figure?4
Figure?4
Results of the probability of cost-effectiveness of differential percentage reductions in the cost of first-line treatment and retreatment, at ￡30 000 willingness-to-pay.
See this image and copyright information in PMC

Similar articles